CHINMAYA INTERNATIONAL RESIDENTIAL SCHOOL

COIMBATORE

APPLICATION FORM

To
The Principal,
Chinmaya International Residential School, Recent
Nallur Vayal Post, Siruvani Road, Passport Size
Coimbatore – 641 114 , Tamil Nadu, India. Photograph

Dear Sir,

Please register my son/daughter/ward on your waiting list as per particulars given below which I certify are true
and correct. If my son/daughter/ward is selected I agree to fully abide by the Rules and Regulations of the
School; Pay the fees in advance and settle any other accounts promptly.

FULLNAME OF THE STUDENT_______________________________________________________________________

(As given in the Transfer Certificate )

NATIONALITY ___________________________ PASSPORT NUMBER______________________________________

_____________________ __________________________ ___________________ ______________________________

Country Place of Issue Date of Issue Date of Expiry

DATE OF BIRTH __________________ PLACE OF BIRTH____________________MOTHER TONGUE ____________________

(Attach Photocopy of the Birth Certificate as issued by the Government Authorities)

SEX: □ MALE □ FEMALE BLOOD GROUP _____________RELIGION________________ CASTE_________________

VEGETARIAN / NON-VEGETARIAN: _____________________________________________________________________

SEEKING ADMISSION FOR CLASS _________________________ FOR ACADEMIC YEAR______________________

ADDRESS FOR CORRESPONDENCE (RESIDENCE ADDRESS)
____________________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

City : ___________________State: ______________________Country: _____________________PIN / ZIP__________

TELEPHONE CODE ____________ Home ________________ Work ________________ Fax_____________________

Mobile _____________________________________ Email _________________________________________________

DETAILS OF SCHOOL LAST STUDIED:

NAME OF THE INSTITUTION ADDRESS CLASS YEAR OF BOARD
PASSING
CANDIDATE’S PROFICIENCY AND ACCOMPLISHMENTS:
Area Achievements
ACADEMIC

SPORTS

MUSIC

ARTS & CRAFT

EXTRA
CURRICULAR

PARENTS DETAILS
DETAILS FATHER MOTHER GUARDIAN
NAME
QUALIFICATION
OCCUPATION
(With Designation)
CONTACT
ADDRESS

OFFICE ADDRESS

CONTACT NUMBER

MOBILE NUMBER
ANNUAL INCOME
E-MAIL ID

RELATIONSHIP TO PAST OR PRESENT STUDENTS

NAME _________________________________ __________________________________________

ROLL NUMBER _________________________________ __________________________________________

RELATIONSHIP _________________________________ __________________________________________

ANY OTHER DETAILS________________________________________________________________________________

______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________
 How did you come to know of our News / Features / Advertisement seen ( please tick and give details)
school ( Tick all applicable)
Details of Source viz., name of media /
Referred by Parent who has a child Media website

studying in our school

Friends Newspaper

Family Magazine

Through our Web site In flight Magazine

Received Email about CIRS Others

ABOUT CURRICULUM
a) FOR XI CBSE
PLEASE SELECT THE CURRICULUM AND SUBJECT STREAM I CLASS XI CBSE
ENGINEERING MEDICINE MANAGEMENT

ENGLISH ENGLISH ENGLISH

PHYSICS PHYSICS BUSINESS STUDIES

CHEMISTRY CHEMISTRY ACCOUNTANCY

MATHEMATICS BIOLOGY ECONOMICS

Select any one of the below Select any one of the below Select any one of the below

BIO-TECHNOLOGY □ INFORMATIC PRACTICES □ INFORMATIC PRACTICES □

INFORMATIC PRACTICES □ PHYSICAL EDUCATION □ MATHEMATICS □
PHYSICAL EDUCATION □ ENTERPRENEURSHIP □ PHYSICAL EDUCATION □
PSYCHOLOGY □ PSYCHOLOGY □ ENTERPRENEURSHIP □
PSYCHOLOGY □
b) FOR IB I YEAR
PLEASE SELECT THE SUBJECT STREAM IN INTERNATIONAL BACCALAUREATE DIPLOMA (IB)
A student has to select one subject from each of the six groups of subjects. The student can opt for an additional
subject from group 3 or group 4 instead of selecting a subject from group 6. Of the six subjects chosen, three must be
studied at the Higher Level (HL) and three must be studied at the Standard Level (SL).
GROUP 1 SUBJECTS GROUP 2 SUBJECTS
Hindi B SL □
English A1 SL □ French AB. SL □
English A1 HL □ French B SL □
GROUP 3 SUBJECTS GROUP 4 SUBJECTS
Economics SL □ Biology SL □
Economics HL □ Biology HL □
Business & Management SL □
Chemistry SL □
Business & Management HL □
Psychology SL □ Chemistry HL □
Psychology HL □ Physics SL □
ITGS HL □ Physics HL □
ITGS SL □ Environmental systems SL □
GROUP 5 SUBJECTS GROUPS 6 SUBJECTS
Mathematics SL □ Visual Arts SL □
Mathematics HL □ Visual Arts HL □
Mathematical Studies SL □
Entrance Examinations Centres (Please Tick)
SELECT ENTRANACE EXAM CENTRE SELECT
ENTRANCE EXAM CENTRE
Ahmedabad Indore
Bangalore Jamshedpur
Chennai Jodhpur
CIRS, Coimbatore Kolkata
Dehradun Lucknow
Delhi Mumbai
Goa Ranchi
Guntur Rourkela
Hyderabad Vadodara
Entrance Examinations For NRI can be conducted in the nearest Chinmaya Mission Centre

PARTICULARS OF REGISTRATION FEE ENCLOSED FOR INR 5000/- (Five Thousand Only) Favouring, CCMT A/C INTERNATIONAL
SCHOOL,
PAYABLE AT COIMBATORE

Draft Number _________________________________ Dated ____________________Bank_________________________________

I understand and agree that registration of my son/ daughter / ward does not guarantee him/her admission into school and
that the registration fee is neither transferable nor refundable.

ENCLOSURES: 1. Copy of Birth Certificate 2. DD of Rs. 5000/-towards Registration Fee

3. Additional Two Passport Size photos.

Our Official Couriers : International : DHL Domestic : DTDC

Date _______________

Name in Block Letters ____________________________________________

Signature _____________________________________________________

Relationship to the Applicant _______________________________________